Epic‘s grip on hospital IT is tightening — yet a surprising number of health systems say they’re still willing to buy elsewhere.
This week, Redesign Health released research proving this. The venture firm surveyed 112 executives at Epic-based health systems across the country — including CEOs, CIOs, CMIOs and other senior decision-makers — to understand how they view Epic and their willingness to buy from outside vendors.
The study found that in general, Epic still owns the market. Hospitals prefer Epic, trust its technology and expect to rely on it even more going forward.
For instance, 71% of the survey’s respondents describe their organization as “Epic-first,” and not a single respondent said they prefer external vendors by default. More than 90% also expressed confidence that Epic will eventually deliver AI tools as good as any outside vendor’s.
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However, for the time being, hospitals are open to buying from startups in specific situations. One of these scenarios is when the product is dramatically better that what Epic is offering, with 49% of respondents saying external vendors must show a “significantly higher” ROI than Epic’s own solution to win the deal.
Another scenario is when the purchase can be sponsored at the department or service-line level, rather than routed through central IT. More than half of respondents said that department leaders have full autonomy to make those calls — at least for now, before the tool eventually gets pulled into the orbit of the greater IT team. This is a meaningful loophole for startups because it means the sales pitch doesn’t have to clear Epic’s home turf first.
Hospitals are also willing to select an outside vendor when Epic’s product in a given category just isn’t strong enough yet. When asked which categories are best-suited for startups to win business this way, respondents pointed to clinician-facing AI like ambient scribing (48%) and imaging AI (44%). These are two categories where Epic has historically moved slower or placed less emphasis than specialized vendors — and patient AI assistants and revenue cycle AI weren’t far behind, according to Redesign’s report.
One of the report’s most surprising findings is how little a startup’s track record might actually matter to health system customers.
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Nearly two-thirds of respondents said they would be likely or very likely to purchase from a net-new startup with three or fewer live customers — which is only 12 percentage points behind their likelihood of buying from an established vendor with hundreds of customers.
Overall, the findings show a market that is consolidating and fragmenting at the same time. Epic is growing even more dominant when it comes to the broad, general-purpose parts of hospital IT — while a somewhat narrow lane remains open for startups willing to solve a specific problem, prove a strong ROI and integrate with minimal friction.
Redesign’s research paints a picture that shows Epic hasn’t closed the door on startups, but it has made the terms of entry a lot more specific.
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